Combined Cognitive-Behavior Therapy Plus Sertraline May Be Best for Children and Adolescents With Obsessive-Compulsive Disorder

Medscape Oct. 27, 2004.

News Author: Laurie Barclay, MD

Combined cognitive-behavior therapy (CBT) with sertraline may be best for adolescents with obsessive-compulsive disorder (OCD), according to the results of a randomized trial published in the Oct. 27 issue of JAMA. �The empirical literature on treatment of obsessive-compulsive disorder (OCD) in children and adolescents supports the efficacy of short-term OCD-specific cognitive behavior therapy (CBT) or medical management with selective serotonin reuptake inhibitors ([S]SRIs),� write John S. March, MD, MPH, from Duke University Medical Center in Durham, North Carolina, and colleagues from the Pediatric OCD Treatment Study (POTS) Team. �However, little is known about their relative and combined efficacy.� In this balanced, masked trial conducted in three U.S. academic centers, 112 volunteer outpatients with a primary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of OCD were enrolled between September 1997 and December 2002. Age range was seven through 17 years, and all patients had a Children�s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score of 16 or higher. Participants were randomized to receive CBT alone, sertraline alone, combined CBT and sertraline, or pill placebo for 12 weeks. The primary outcome was change in CY-BOCS score for 12 weeks as rated by an independent evaluator masked to treatment status. Clinical remission was defined as a CY-BOCS score not greater than 10. Of 112 patients, 97 patients (87%) completed the 12-week study. Based on intent-to-treat random regression analyses, there was a significant advantage for CBT alone (P = .003), sertraline alone (P = .007), and combined treatment (P = .001) compared with placebo. Combined treatment was superior to CBT alone (P = .008) and to sertraline alone (P = .006), but CBT alone and sertraline alone did not differ from each other. There were site differences for CBT and sertraline but not for combined treatment, suggesting that combined treatment is less susceptible to site-specific variations. Clinical remission rate was 53.6% (95% confidence interval [CI], 36% to 70%) for combined treatment; 39.3% (95% CI, 24% to 58%) for CBT alone; 21.4% (95% CI, 10% to 40%) for sertraline alone; and 3.6% (95% CI, 0% to 19%) for placebo. Although the remission rate for combined treatment was not different from that for CBT alone (P = .42), it was higher than that with sertraline alone (P = .03) or with placebo (P < .001). CBT alone did not differ from sertraline alone (P = .24). CBT alone was better than placebo (P = .002), but sertraline alone was not (P = .10). �The three active treatments proved acceptable and well tolerated, with no evidence of treatment-emergent harm to self or to others,� the authors write. �Children and adolescents with OCD should begin treatment with the combination of CBT plus a selective serotonin reuptake inhibitor or CBT alone.�

Kilde: Medscape:

Combined Cognitive-Behavior Therapy Plus Sertraline May Be Best for Children and Adolescents With Obsessive-Compulsive Disorder. Originalt Abstract kan l�ses p� Journal of American Medicine Associations

(JAMA) hjemmeside: Cognitive-Behavior Therapy, Sertraline, and Their Combination for Children and Adolescents With Obsessive-Compulsive Disorder JAMA. 2004;292:1969-1976. The Pediatric OCD Treatment Study (POTS) Randomized Controlled Trial. The Pediatric OCD Treatment Study (POTS) Team: Principal investigators: Duke University Medical Center: John S. March, MD, MPH; University of Pennsylvania: Edna Foa, PhD; Coinvestigators: Duke University Medical Center: Pat Gammon, PhD, Allan Chrisman, MD, John Curry, PhD, David Fitzgerald, PhD, Kevin Sullivan, BA; University of Pennsylvania: Martin Franklin, PhD, Jonathan Huppert, PhD, Moira Rynn, MD, Ning Zhao, PhD, Lori Zoellner, PhD; Brown University: Henrietta Leonard, MD, Abbe Garcia, PhD, Jennifer Freeman, PhD; Principal Statistician: Xin Tu, PhD (University of Pennsylvania).

Se desuden: Innovations Raport og National Institute of Health News: Psychotherapy, Meds Best for Youth With Obsessive Compulsive Disorder